Imagine that you are attending a symposium in Prague, Czech Republic, perhaps at an old-world hotel overlooking the Vltava river. The symposium is hosted by 2 seasoned academic neurosurgeons from the city, who invited several European colleagues and 1 Japanese guest to address the topic of brain arteriovenous malformations (bAVMs). You would learn a great deal in such a gathering, about the lecturers’ unique perspectives on bAVMs and their interpretation of current knowledge and techniques in light of their experiences. A book summarizing the lectures from such a symposium would look very much like this monograph, edited by Beneš and Bradáč. The largely Eurocentric perspectives are very interesting, and not much different from multidisciplinary thinking about this entity by other advanced and experienced teams worldwide. Some of the information can be found elsewhere, but here it is nicely collated in a single 240-page volume, albeit with great variability in quality, style, scope, and selectivity of content. The chapter by Tanaka on lesion definition and angioarchitecture is a masterpiece, fusing information from embryology, vasculogenesis, and angiogenesis into a clinician's view of the pathological lesion. Similarly, the chapter by Amyere, Boon, and Vikkula crisply and cogently summarizes diverse concepts from a huge basic science landscape about the molecular mechanisms involved in bAVM pathobiology. The chapter title, “Genetics of Arteriovenous Malformations,” betrays this broader scope, and the authors seem to evade information about differential gene expression, transcriptomics, and biomarkers that should be linked to the molecular mechanisms. Both chapters seem to ignore the cardinal role of inflammation and microhemorrhages (elegantly highlighted by the University of California researchers and others), and do not differentiate between mechanisms of lesion genesis, progression, and clinical sequelae. The chapter on epidemiology and natural history by Laasko relies heavily on the strong Finnish data, and less on recent population studies from Scotland and other contributions. It does not emphasize the huge differences in natural risk when combining features of superficial vs deep lesion location, venous drainage, and prior hemorrhage (as demonstrated by the Columbia, New York group and in other meta-analyses). The chapter by Al Awar and Patel, entitled “Pathophysiologic View largeDownload slide View largeDownload slide Principles” in fact presents an elegant and scholarly history of the conceptualization of these principles rather than a scientific summary of the pathophysiology. The clinical chapters are mostly experiential, reflecting the authors’ personal biases and outcomes. Clinical vignettes are useful, but the quality of the imaging and surgical photography is generally poor (low resolution, often dark, and not well highlighted). The endovascular chapter by the very experienced French team from Lariboisière Hospital is technically focused. But it evades careful outcomes assessment, and does not present cogent multidisciplinary strategies combining embolization and surgery. The chapters on radiosurgery and on the neurological outcomes and efficacy of AVM treatment diligently present novel meta-analyses of the published literature, and a mature interpretation of these results. Conversely, the chapter on neuropsychological outcome is a single center report, with little consideration of the broader literature. A chapter is dedicated to the editors’ comments on the ARUBA Study, yet a counterpoint by European ARUBA investigators is missing. This monograph summarizes many current perspectives in the field, but it breaks no new ground. Beginning students might learn better about bAVMs in other recent encyclopedic neurosurgery and neurovascular textbooks. More experienced neurovascular specialists probably already know much of the information herein. Yet, the more I read the various chapters, the more pearls I gleaned, as if interacting with the authors, and probing their thinking at a symposium. Kafka has said that “Prague never lets you go.” I felt the same about this book. Disclosure The author has no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Copyright © 2018 by the Congress of Neurological Surgeons This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Neurosurgery – Oxford University Press
Published: May 8, 2018
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